023 Risk Stratification Using CHA2DS2-VASc and CHADS2 Scores in Patients With Chronic Atherosclerotic Cardiovascular Disease Receiving Aspirin With or Without Rivaroxaban: An Analysis of the COMPASS Trial

The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that rivaroxaban plus aspirin reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD). We explored whether the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke/transient ischemic attack/thromboembolism, vascular disease, age 65-75 years, and sex category) and CHADS2 scores can identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment. The predictive accuracies of the CHA2DS2-VASc and CHADS2 scores for the primary outcome, MACE, were assessed in COMPASS patients. Kaplan-Meier estimates of cumulative risk were used to compare the effects of rivaroxaban plus aspirin with aspirin alone according to risk score categories. A high CHA2DS2-VASc score (6-9) was associated with 3 times greater absolute risk of MACE compared to a low score (1-2) (hazard ratio=3.39, 95% CI: 2.54-4.51, p<0.0001). The effects of rivaroxaban plus aspirin compared with aspirin alone were consistent across CHA2DS2-VASc and CHADS2 score categories for MACE, bleeding and net clinical benefit, with greatest reduction in MACE observed in patients treated for 30 months with highest CHA2DS2-VASc score (6-9) (23 events per 1000 patients prevented) or highest CHADS2 score (3-6) (25 events per 1000 patients prevented). The CHA2DS2-VASc and CHADS2 scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE, and who achieve the greatest benefit of dual pathway inhibition with rivaroxaban and aspirin.